Glossary
Please use the letter links below to jump straight to the topic you would like a definition for - topics are in alphabetical order.
A B C D E F G H I K L M N O P R S T U W
| Word | Definition |
| A | |
| Accident | An accident means an unforeseen event occurring by chance and caused by an unintentional and external force or object, resulting in involuntary hurt or damage to the body, which requires immediate medical advice or treatment from a registered practitioner other than the member or the member's immediate family. |
| Acupuncture | The treatment of the disease by influencing
points on meridians, or 'lines of energy' which interconnect across the
body surface and relate to major organs of the body. This is most commonly
done by the insertion of fine needles, or by warming with moxibustion. |
| Allied Health Services | These are extra services offered by a hospital
outside the core services of accommodation, theatre fees, PBS drugs and
labour
ward fees. Examples include:
|
| Ambulance services | Ambulance services are covered on top of
most of our hospital covers. The level of cover you receive is dependent
on the provisions of your state of residence.
If you live in VIC, SA or NT you will receive cover for capped recognised emergency-only ambulance transport services or on-the-spot treatment. If you live in NSW or ACT, you pay an ambulance levy as part of your hospital cover premium. This entitles you to recognised emergency-only ambulance services under the State Government ambulance transport schemes in every state except QLD and SA. When you receive an account for ambulance services in any state except QLD and SA, simply send it to us and we will endorse it for you to send back to the appropriate ambulance transport scheme. In QLD and SA you will receive cover for capped recognised emergency-only ambulance transport or on-the-spot treatment. If you live in QLD or TAS you will receive full ambulance cover under your state ambulance service. If you fall outside of your state based arrangement, you will receive cover for recognised emergency-only ambulance transport or on-the-spot treatment. If you live in WA you will receive full ambulance cover nationwide, including uncapped non-emergency transportation and on-the-spot treatment. Cover for recognised emergency-only ambulance transport services or on-the-spot ambulance treatment on top of your hospital cover is is capped at one service for a single membership and two services for couple, single parent and family memberships each calendar year - unless you have Ambo Cover, in which case you are covered for unlimited emergency services. We define an emergency as an event that is unplanned, non-routine, and in which you require immediate medical attention. You are not covered for transportation from a hospital to: your home, a nursing home, or another hospital (where the member has been admitted to the transferring [first] hospital). You are also not covered for transportation from the member’s home, a nursing home or hospital for ongoing medical treatment, e.g. Chemotherapy or dialysis. If you do not have an ambulance subscription with your state ambulance service or have fallen outside of a state based arrangement and need to make a claim for emergency ambulance services covered on top of your hospital cover, please complete and return to us the Particulars of Ambulance Transportation form. |
| Ancillary Cover | Ancillary cover is what we refer to as extras
cover. Our extras cover options provide you with cover for services such
as:
For instance, Premier Extras is a type of ancillary or extras cover.
|
| Assisted Reproductive Services | The process of conception through a method
other than the natural method. |
| B | |
| Benefit | The amount we pay for services provided
to you whilst you are in hospital under one of
Mutual Community
's hospital covers, or for extras services under one of
Mutual Community
's extras cover. |
| Benefit Bonus | Every time you claim*, we give you a Benefit Bonus on top of the amount you get back on your treatments. This bonus increases by 2% every year, up to a maximum of 10%. Your Benefit Bonus starts after your first year of membership on extras cover with us. If you already have extras cover with us, we'll recognise your years of loyalty. This feature is only available on Platinum Extras, Gold Extras and Silver Extras. *Annual Maximums apply. Normal fund rules apply upon upgrading. |
| Bowen Technique | A dynamic system of muscle and connective
tissue movements that effectively realigns the body to balance and stimulate
energy flow, empowering the body's own resources to heal itself. Bowen involves
light, simple and pain-free vibrational therapy. |
| C | |
| Claim | One or a number of invoices a member (or
provider on behalf of a member) presents to a health fund for the payment
of benefits. The invoices may relate to Hospital, Extras or medical services.
If the invoices are unpaid, the hospital, doctor or ancillary provider may
in some instances claim the benefits directly from the fund on the member's
behalf. The member would then only be required to reimburse the provider
with the balance owing. Unless claiming on-the-spot electronically, via
HiCaps or Ezyclaim, a member must complete the appropriate claim form and
attach all documents and receipts relating to the claim. |
| C-POS | An electronic claiming facility for Extras.
|
| Cosmetic Surgery | Any type of surgery where Medicare does not pay a benefit. Some examples of cosmetic surgery are:
|
| Co-payment | An agreed amount paid by the member towards
the cost of each day spent in hospital. |
| Conditions of membership | When you take out private health insurance
(cover) with us, you become a member of our fund. The terms and conditions
of your membership are governed by Our Fund Rules. However, some
of the key terms that apply to your cover are also included in our Frequently
Asked Questions (FAQs). Please note that not every term that applies to
your cover is included in our FAQs but they are all contained in Our
Fund Rules. A full copy of these can be obtained from our Head Office
or by contacting one of our Customer Service Consultants on 131 243.
Before you take out cover with Mutual Community , it is advisable to take the time to read either or both our FAQs and Our Fund Rules. If you have any further questions, we encourage you to contact us When you take out cover with us and become a member of our fund, you consent to our collection, use and disclosure of your personal and health information for us to provide private health insurance to you. If you take out a Family, Family Plus or Couples membership you acknowledge that we may collect, use and disclose personal and health information about the other people on your membership and the person nominated as owner of the membership will be notified of details of services claimed under the membership, which may include personal and health information about you and those other people. You are responsible for ensuring that those other people on your membership are aware, before you include them, that by being included on and claiming under the membership, their personal and health information will be disclosed to the owner of the membership. We may end your membership at any time if you have not paid your premiums for two months or are in breach Our Fund Rules. |
| Compensation and Damages from other sources | Benefits are not payable where compensation
and/or damages may be claimed from another source. For example:
|
| Chiropractic | A system of treating disease by manipulation
of the spinal column that is based on the scientific fact that your body
is a self-regulating, self-healing organism whose important functions are
controlled by the brain, spinal cord and all the nerves of the body. |
| Chinese Herbalism | The treatment of a wide range of conditions
with the use of raw herbs as well as a vast array of prepared or patented
medicines available in manufactured pill granule and powder form. |
| Cataract Surgery | An area of surgery devoted to the replacement
of an opaque lens with a clear, artificial one. |
| Cardiovascular Surgery | An area of surgery devoted to the treatment
of the heart and great vessels. |
| Calendar Year | Benefits are paid by
Mutual Community
on a per calendar year basis. Calendar year is defined by
Mutual Community
as 1 January to 31 December no matter what date you join
Mutual Community
. |
| Change of Cover | When changing your level of cover, the lower level of benefits apply for 12 months for pre–existing ailments and pregnancy (childbirth). Restricted Benefits may apply for specific services. If changing to another cover you may no longer receive Excess Bonuses or your Excess Bonuses may be cancelled, please contact us for details. If you are changing from another Australian health fund to Mutual Community you may receive Restricted Benefits for some services if specified on your cover with Mutual Community. You will continue to be covered for all benefit entitlements on your new cover that you had on your old cover, as long as you transfer to Mutual Community within 30 days of leaving the previous fund. This is referred to as 'continuity of cover'. Where your level of cover differs from your cover with your old fund, the lower level of benefits applies for pre-existing ailments in the first 12 months. Please contact us on 131 243 if you have any queries or require further information. |
| D | |
| Domiciliary care | Defined as non-medical treatment such as
personal assistance, showering and dressing that is not covered under home
nursing. |
| Dietary | The science or study and regulation of the
diet. A Dietician is a person who is trained in the scientific use of diet
in the promotion of health and treatment of disease. |
| Dependants | On Single Parent and Family memberships,
dependants include single children under 17 years and single, full-time
students under 25 years. On Family Plus memberships, dependants include
single children (students and non-students) under 25 years even if they
live away from home. |
| Default Benefits | The minimum level of benefits registered
private health insurers must pay in respect of members' claims for treatment
provided in public hospitals, non-contracted private hospitals and day surgeries.
Default benefits are set by the Government and are usually amended around
July of each year. Each Hospital product offered by a fund must include
a "Default" component, however some products specifically exclude certain
types of treatment. |
| E | |
| Endodontists | Specialise in the treatment of disease associated
with and injuries to the root canal and it surrounding tissues. |
| Excess | You can reduce your premium by agreeing
to pay a fixed amount towards the cost of your hospital admissions, including
same day treatment. The agreed amount is called the Excess. Excess amounts
vary with choice of product. |
| Excess Bonus | Some hospital covers offer the Excess Bonus feature, which entitles you to 1 excess-free overnight or same day hospital admission per calendar year on a single or single parent membership, and 2 excess-free overnight or same day hospital admission per calendar year on a family membership. If you have hospital cover that offers the Excess Bonus feature and have also accumulated Excess Bonus dollars prior to 1 April 2007, you will be able to use your Excess Bonus dollars towards the payment of any excess on a dollar for dollar basis once you have used your excess-free hospital admission/s. |
| Exclusions | Exclusion of a service means that no benefits
are payable for that service. |
| Extras Cover | Extras (or ancillary) cover is private health
insurance for health services that are not covered by Medicare and are provided
to you by a Recognised Provider in certain health professions, such as:
|
| Eye Therapy | A technique that involves eye exercises
designed to correct the visual axes of eyes not properly co-ordinated for
binocular vision. |
| Electronic claiming | You can claim on-the-spot electronically
where you get your treatment by swiping your membership card through a dedicated
C-POS apparatus. |
| F | |
| Fund | The fund is BUPA Australia Health Pty Ltd
(BUPA), which trades as
Mutual Community
. |
| Family membership | Covers the member, their partner, plus single
children under 17 years and single full-time students under 25 years. |
| Family Plus membership | Covers the member, their partner, plus single
children (students and non-students) under 25 years even if they live away
from home. |
| G | |
| Government Rebate | Refers to the Federal Government Rebate
on private health insurance. The Government Rebate is available to everyone who is eligible for Medicare and has private health insurance. The Rebate applies to both Hospital and Extras premiums and is not means tested. The amount of Rebate you are entitled to is calculated based on age or whether a Savings Provision Entitlement is applied to your membership. There are three levels of rebate:
|
| General Dental | Dentistry is defined as the department of
healing arts that is concerned with the teeth, oral cavity and associated
structures, including the diagnosis and treatment of their diseases and
the restoration of defective and missing tissues. Treatment can include:
Such services are performed by:
|
| General Hospital Costs | Fees for the services incurred by a person
who is admitted as a hospital in-patient. General hospital costs consist
of accommodation fees, theatre and labour ward fees, drugs, dressings and
local phone calls. If a patient is in a critical condition, an intensive
care room fee may also apply. |
| H | |
| Health Appliances | Includes a range of health equipment items
that people may use to assist them with daily living activities, such as
asthma pumps (approved by the Asthma Foundation), glucose meters (approved
by Diabetes Australia) and so on. |
| Home Nursing | Nursing care provided in the home where
it is in lieu of hospitalisation. Does not include feeding, clothing etc.
|
| Homoeopathy | A system for treating disease based on the
administration of minute doses of medications that in massive amounts produce
symptoms in healthy individuals similar to those of the disease itself.
|
| Hospital Accommodation | When a patient is admitted to a hospital
or day facility, occupying a bed and receiving nursing care for the purpose
of receiving treatment from a doctor. |
| Hospital Treatment | Treatment provided to you during admission
to a hospital, whether it is overnight or on the same day. |
| I | |
| In-patient | A person who is treated whilst in hospital
and receives hospital accommodation. |
| Intensive Care fees | The fees incurred by a patient when they
are deemed to require intensive care in a recognised intensive care facility.
|
| K | |
| Kinesiology | Kinesiology (the science of movement) combines
muscle testing and monitoring, with the principles of traditional Chinese
medicine to assess energy and body function, applying a range of gentle
yet powerful healing techniques to improve health, well-being and vitality.
|
| L | |
| Loyalty Maximums | The amount you can claim each year on your
membership under your Extras cover.
With most Extras services, you receive an annual maximum, which is the available benefit limit for all persons covered under the membership. For some Extras services, after you have had Extras cover for 12 months,
your annual maximum will automatically increase each year until it's double
the amount when you joined. |
| Labour Ward Fees | Fees incurred by maternity patients for
the usage of the delivery room during confinement in hospital. |
| Level of Cover | Refers to the type/level of private health
insurance you have. Level of cover varies depending on the number of services
covered by the product(s) and the amount paid for the product(s). |
| Limitations to Cover | Limitations to your cover include:
|
| Lifetime Health Cover | A Federal Government initiative introduced
on 1 July 2000. Based on the age at which you took out private health insurance
for the first time you may have to pay a Lifetime Health Cover loading on
your Hospital cover premiums. |
| M | |
| Membership | Refers to a policy. It indicates the product
or products that you have bought and the people covered |
| Membership type | Refers to the number and status of persons
that can be covered under a particular policy. There are five membership
types: Single, Couple, Single Parent, Family and Family Plus. |
| Medicare Levy Surcharge | A Government surcharge imposed on income
earners who do not have private health insurance. The levy is an additional
1% on top of the current Medicare levy of 1.5% and applies to:
|
| Medicare | A compulsory Federal Government public health
insurance scheme covering all Australian residents. It is partly funded
by a levy on taxable income and covers public hospital treatment and doctor
services. |
| Medically necessary | When treatment is deemed necessary by a
medical practitioner. |
| Massage | The therapeutic use of human touch. Combination
techniques are used to enhance the healing process of the soft tissue
(muscles, tendons and ligaments), facilitating a therapeutic response
to many body systems. For benefit purposes 'massage' includes the modalities
of Remedial, Oriental, Therapeutic or Sports Massage, Myotherapy, Shiatsu,
Reflexology, Bowen, Aromatherapy Massage and Kinesiology.
|
| Major Dental | Covers items such as:
|
| Mouthguards | An elastoplastic removable appliance to
protect teeth and the tissues in contact sports. |
| N | |
| Non-Participating Private Hospitals | Private hospitals we do not have an agreement
with. If you go to a non-participating private hospital, we pay lower
benefits
which are unlikely to cover the cost of your stay. Therefore you may incur "out-of-pocket" expenses. |
| Natural therapies | Covers alternative therapies including:
Naturopathy, Acupuncture, Homoeopathy, Western Herbalism, Chinese Medicine,
Massage, Shiatsu, Kinesiology, Bowen Technique and Reflexology. |
| Naturopathy | A system of dealing with internal health
problems, metabolic disorders and imbalances through treatment of the whole
person. In general, a wide range of diagnostic techniques is employed to
assess causative factors and treatment may involve dietary changes, herbal
medicines, homoeopathy, bodywork or nutritional supplements. |
| O | |
| Oral Surgeons | A dentist with special training in surgery
of the mouth and jaw. |
| Osteopathy | This involves massage and the manipulation
of joints, especially the vertebrae of the spine, to correct skeletal misalignment
and encourage self-healing. |
| Orthodontists | An orthodontist prevents and treats badly
aligned teeth and jaws. That is, an orthodontist re-arranges the natural
teeth for functional and cosmetic reasons |
| Oral and Maxillofacial Radiologist | An oral and maxillofacial radiologist is
a fully qualified dentist who is also a qualified radiologist specialising
in taking, interpreting and reporting on X-rays at the request of other
dentists. |
| Optometry | The treatment of people with visual problems.
It involves the diagnosis and treatment of dysfunctions of the eye and vision.
|
| Occupational Therapy | The treatment of people who are affected
by developmental delay, ageing, injury, and physical, psychological or social
disability. |
| Ombudsman | If you have a complaint or query regarding
your cover or the terms and conditions that apply to your cover (these are
called "Our Fund Rules"), please contact one of our Customer Service
Consultants on 131 243.
Our consultants will endeavour to resolve any issues you may have but if you are not satisfied with our response, you can contact the Private Health Insurance Ombudsman, which has been established by the Commonwealth Government to deal with enquiries and complaints about any aspect of private health insurance. Please call 1800 640 695 or visit www.phio.org.au. |
| P | |
| Palliative Care | Palliative Care is specialised health care provided by experts with training and experience in supporting people living with a terminal illness and their family. |
| Participating Private Hospitals | Participating Private Hospitals include
Members First private hospitals, most other private hospitals, and private
rooms at public hospitals throughout Australia. If you have private hospital
cover, at any Participating Private Hospital you're fully covered for
the following in-hospital expenses for as long as medically necessary:
You are covered for the cost of any medical treatment up to the Government Schedule fee - this is the amount set by the Federal Government for each medical service covered by Medicare. Medicare pays 75% of the Schedule fee and Mutual Community pays the remaining 25%. If your specialist charges more than the Schedule fee, there will be a ‘gap’ for you to pay. However, our Ezyclaim system can help to eliminate or reduce the gap for you. To find a Participating Private Hospital in your area or by name, simply go to Find a hospital. |
| Participating Optical Dispensers | Optical providers who have entered into
an agreement with the Fund for the payment of benefits higher than the
set benefits available. |
| Pharmacy | The art of preparing, compounding and dispensing
medicines. |
| Prosthodontists | Specialise in advanced restorative treatment
of the teeth and surrounding tissues by artificial means such as crowns,
bridges and dentures. |
| Premium | The premium is the amount you pay for the
hospital cover or extras cover that you choose. We can change the premiums
we charge but only once a year and only with the approval of the Minister
for Health. Premium changes come into effect each April. You will be notified
of any change before it comes into effect. You must pay the premium that
applies to your cover in the state in which you live. This means that if
you move, we will adjust your premiums. If your cover is unavailable in
the new state, we will transfer your membership to the nearest equivalent
cover available in that state. |
| Pregnancy related services | Medical services that are directly related
to pregnancy and childbirth such as ante-natal services, complications of
pregnancy, delivery itself and post natal care of the mother. |
| Pre-existing ailment rule | Benefits are not payable during the first
12 months of membership on certain levels of cover for matters related
to a
"pre-existing ailment". A pre-existing ailment is an ailment, illness or
injury that you had signs or symptoms of at any time during the six months
before you took out cover (including if you have upgraded), whether or
not you knew you had it. |
| Podiatry | Prevention, diagnosis, treatment and rehabilitation
of medical and surgical conditions of the feet and lower limbs. |
| Psychology | The branch of science which deals with the
mind and mental processes, especially in relation to human behaviour. |
| Persons covered | Refers to the number of people that are
covered by a policy. For instance, a single membership covers only one person,
a couples membership covers two people, a family membership can cover two
or more people. |
| Periodontists | Specialise in the prevention and treatment
of the tissues (the gums and underlying bone) which support the teeth. |
| Pedodontists | Specialise in the diagnosis and treatment
of conditions of the teeth and mouth in children. |
| Pharmaceutical Benefits Scheme (PBS) | PBS is a scheme funded by the Commonwealth
Government to subsidise certain drugs. It is administered by Medicare. If
you take out hospital cover, we will pay for PBS drugs provided as part
of your hospital treatment when admitted to hospital. |
| Physiotherapy | A combination of manual therapy, movement
training and physical and electro-physical agents. The primary focus of
physiotherapy is the restoration of function. Physiotherapists assess and
diagnose the problem, then plan and administer the programs that aim to
restore function or minimise dysfunction after disease or injury. |
| Psychiatry | Psychiatry is a field of medicine which deals with the diagnosis, treatment and prevention of mental, emotional and behavioural disorders. It integrates biological, social and psychological aspects of mental health to provide holistic medical care for a wide range of symptoms. |
| R | |
| Restricted Benefits | Benefits paid for a service at an amount
set by the Government. Some hospital covers have Restricted Benefits for
certain services, meaning that you will receive a lower level of benefit
(payment) for those services. |
| Rebate | The amount we pay for services provided
to you whilst you are in hospital under one of
Mutual Community
's hospital covers or for extras services under one of
Mutual Community
's extras cover. |
| Recognised Providers | A provider recognised by the fund in private practice that provides a professional health service (other than a registered medical practitoner) for which a Medicare benefit is not payable but for which we agree to pay a benefit under extras cover. If we do not recognise a particular provider, we will not pay benefits for services they provide to you. |
| Reflexology | A technique whereby a therapist applies
pressure to acupuncture points on the ears, hands, and feet. |
| Rehabilitation | Rehabilitation is a program that helps a person who is recovering from illness or injury to regain as much function as possible. The aim is for clients to become as independent as possible despite his/her disabilities. Rehabilitation also aims to teach strategies for ongoing disabilities. |
| S | |
| Speech Therapy | Assessment and treatment of people who have
a communication disability. Communication disabilities are the result of
problems with speech, using and understanding language, voice, fluency,
hearing, or reading and writing. |
| Single membership | Covers the individual member only. |
| Single Parent membership | Covers the member plus single children under 17 years and single full-time students under 25 years. |
| Shiatsu | A pressure-point massage technique developed
in Japan. Finger pressure is applied to specific points on the body to stimulate
"meridians" (pathways through which it is thought life energy flows). |
| Savings Provision Entitlement | There are circumstances where you may be
entitled to an increased Government Rebate.The Savings Provision Entitlement
ensures that people remaining on a policy that has been eligible for the
35% or 40% Government Rebate do not have their rebate amount reduced to
30% when the person aged 65 years or over leaves or cancels the policy.
The Savings Provision Entitlement only applies when the person 65 years
or over leaves or cancels the policy after 1 April 2005. Anyone who is aged
under 18 or a full-time student under the age of 25 at the time the person
leaves the membership cannot inherit the 35% or 40% Rebate. |
| Schedule Fee | An amount set by the Federal Government
for each medical service covered by Medicare. This amount is used to determine
the rebate payable by Medicare. It is reviewed at least once a year to take
inflation into account. |
| T | |
| Table | This is the way that a health insurer may
refer to your product. For example, our Premier Extras cover is also referred
to as Table M. |
| Theatre fees | Fees that a hospital bills to a patient,
or directly to a fund, for the usage of the operating room. |
| Therapeutic Massage | A blend of approved, scientific massage
techniques promoting efficiency in the body's systems, which in turn enhances
the functioning of the entire person. |
| Transferring from another fund | If your cover starts within 30 days of the
end of your cover with another health fund, we will take into account any
Waiting Periods served by you before joining
Mutual Community
. If your level of cover with
Mutual Community
pays a benefit for a service not covered under the cover you had with the
other health fund, we may require you to serve a Waiting Period for that
service before benefits are paid. If you are a member of another health fund, but wish to transfer to Mutual Community , please refer to our information on the switching process. Where an extras benefit or benefit limit with Mutual Community differs from your cover with your previous fund, the lower benefit or limit applies for the first 12 months. |
| Travel and Accommodation | Benefits are payable for expenses associated with essential medical or hospital treatment where the total return distance travelled is at least 300 kilometres. Overnight non-hospital accommodation benefits are payable for the patient and an attendant for travel away from home for treatment unable to be provided by the patient’s own doctor. |
| U | |
| Unemployment Cover | If you are on a level of hospital cover that offers Unemployment Cover and you are involuntarily retrenched or made redundant from full-time employment, from the start of the second month we will pay your health insurance premium (at the same level of cover) for up to 12 months as long as you remain unemployed. The main conditions are:
|
| W | |
| Western Herbalism | Classical herbal medicine that utilises
the Hippocratic principles of treating the person, not the disease. It evaluates
the patient's lifestyle and the emotional, circumstantial environment of
the patient, not just the physical symptoms. Individually applicable herbal
extracts and tinctures are then prescribed. |
| Waiting Periods | A Waiting Period starts from the date you
join private health insurance. During a Waiting Period you are not covered
and will not receive any
benefits for the types of treatment affected by the Waiting Period. Once
the Waiting Period is over, you will receive the full benefits listed
under
your level of cover for that treatment type. All hospital covers have 12
month Waiting Periods for pre-existing ailments and pregnancy (childbirth),
where applicable.
If you transfer to Mutual Community from another health fund on an equivalent level of cover we will honour all the Waiting Periods you have already served when we receive confirmation of your previous membership and level of cover, but you will need to join Mutual Community within one month of leaving the other fund. When you upgrade to a higher level of cover, the benefits from your previous level of cover apply during Waiting Periods. |
